ObjectivesTo explore the statistical performance of different methods for meta-analysis of single rates with zero events so as to provide evidence for selecting meta-analysis methods in evidence-based research.MethodsThrough Monte-Carlo simulations, we evaluated the performance of various transformation and correction methods for meta-analysis of single rates with zero events, considering the point estimate bias, confidence interval coverage and width.ResultsWhen the overall event rate was above 30%, all methods showed good statistical performance. As the event rate dropped, log, logit, and arcsine transformations could still maintain good performance. However, when the event rate was less than 5%, only Freeman-Tukey transformation showed excellent performance.ConclusionsThe meta-analysis of single rate based on Freeman-Tukey transformation is robust, and should be recommended as the preferable choice of meta-analysis of single rate with zero events.
In order to compare the immunogenecity and biological properties of homologous tendon grafts after treatment from different methods of freezing, tendons from chickens received repeated freezing-thawing treatment or ultra-low-temperature treatment, and then, the post-treatment tendons were preserved in liquid nitrogen for 3 months before transplantation. The autogenous tendon transplantation was served as the control. It was found that in the group of repeated freezing-thawing treated tendons, the tendon cells all died and while in the ultra-low temperature treated tendons the active rate of tendon cells was 92.5% +/- 3.4%, and the histological observation showed that transplantation of frozen tendons would result in extensive infiltration of inflammatory cells in the grafted tendons and the peritendinous adhesion was serious than that of the autografts. The active flexion function, hydroxyproline levels and the biomechanical analysis showed no significant differences between the repeated freezing-thawing treated homografts and the ultra-low-temperature treated homografts, and that the autografts was definitely superior to the homografts. The conclusions were: (1) Transplantation of the homologous tendons from the two different methods of freezing could receive considerable success and there was no significant difference between them; (2) Transplantation of frozen homologous tendon graft might give successful result which was probably due to the preservation of the cellular activity of the tendon cells following freezing treatment and elimination of the antigen presenting cells in the tendon as well, and (3) Although the cellular components of the tendon were damaged and the antigenicity of the tendon was lowered, it did not necessarily mean that homologous tendon graft would always be successful in transplantation.
Objective To study the method and effect of free rectusabdominis muscle flaps with intermediate split thickness skin graft in repairing defects on legs and ankles.Methods From May 1998 to December 2002, 11 cases of defects on legs(2 cases) and on ankles( 9 cases) were repaired by use of unilateral free rectus abdominis flap with skin graft. The soft tissue defects were accompanied by osteomyelitis or the exposure of bone or tendon.The disease course was 1 month to 10 years. The defect size ranged 3 cm×4 cm to 8 cm×14 cm. The area ofrectus abdominis muscle flaps was 4 cm×6 cm to 8 cm×15 cm. Results All patients were followed up 6 months to 4 years after operation. All rectusabdominis flaps survived with good appearances and functions.The primary healing was achieved in 8 cases, intermediate split thickness skin graft necrosed in 3 cases and the wound healed after skin re-graft.Conclusion Free rectus abdominis flap is a proper option for repair of the soft tissue defects or irregular woundson legs and ankles. It has the advantages of abundant blood supply, b anti-infection ability, good compliance and satisfied appearance.
OBJECTIVE: To study the availability of transplantation of anterolateral femoral skin flap with absence of the first branch of musculocutaneous artery. METHODS: One hundred and sixty cases of anterolateral femoral skin flap transplantation in the past 15 years were reviewed, to investigate the relationship between the outcome of the transplantation and the types, distribution, original point, diameter of blood vessels. Among the 160 cases, there were 10 cases, 6.3% in total, of skin flap transplantation with the pedicle of high site direct cutaneous femoral artery, ranging from 10 cm x 14 cm to 12 cm x 18 cm in size, applied to repair soft tissue defect. RESULTS: There were 149 cases, among the 160 cases, survived and all the 10 cases of femoral skin flap transplantation with high site anterolateral cutaneous artery survived. CONCLUSION: The femoral skin flap with high site anterolateral cutaneous artery has good blood supply, larger size available, and easier operation. When the first branch of descending anterolateral femoral artery is absent, the femoral skin flap with high site anterolateral cutaneous artery is an optimal alternative.
OBJECTIVE: To explore the clinical result of velopharyngeal cerclage in repairing velopharyngeal incompetence of postoperative cleft palate patients. METHODS: From 1987 to 2000, 25 cases of velopharyngeal incompetence due to postoperative cleft palate were given the velopharyngeal cerclage. The mucosa flap of palate was pushed back, the autogenous free grafts of denervated skeletal muscle were selectively used for velopharyngeal cerclage. All the patients were followed up for 2 and a half years on average. RESULTS: All the patients achieved good results with velopharyngeal competence and good articulation. The patients’ sound of voices was clear. CONCLUSION: This method can be used to repair velopharyngeal incompetence of postoperative cleft palate patients; the operation is simple and the results are satisfactory.
Objective To investigate the effectiveness and adverse effect of the absorbable fixation system on cranial bone flap reposition and fixation after craniotomy. Methods Between July 2010 and December 2011, 67 cases underwent cranial bone flap reposition and fixation with absorbable fixation system after craniotomy and resection of intracranial lesions. There were 38 males and 29 females with a median age of 32 years (range, 5 months to 73 years). The disease duration ranged from 3 months to 6 years (median, 25 months). Forty-one lesions were located at supratentorial and 26 at subtentorial, including at the frontotemporal site in 13 cases, at the frontoparietal site in 12 cases, at the temporal oprietal site in 8 cases, at the temporooccipital site in 5 cases, at the occipitoparietal site in 4 cases, and at the posterior cranial fossa in 25 cases. The diagnosis results were glioma in 15 cases, cerebral vascular diseases (aneurysm, arteriovenous malformation, and cavemous angioma) in 8 cases, meningioma in 7 cases, arachnoid cyst in 7 cases, acoustic neurinoma in 5 cases, cholesteatoma in 3 cases, primary trigeminal neuralgia in 5 cases, cerebral abscess in 3 cases, hypophysoma in 2 cases, craniopharyngioma in 2 cases, metastatic tumor in 2 cases, radiation encephalopathy in 2 cases, medulloblastoma in 1 case, ependymocytoma in 1 case, germinoma in 1 case, atypical teratoma/rhabdoid tumor in 1 case, facial spasm in 1 case, and subdural hematoma in 1 case. Intracranial lesion size ranged from 3 cm × 2 cm to 7 cm × 5 cm. The changes of local incision and general condition were observed. Results Subcutaneous effusion occurred in 2 supratentorial lesions and 3 subtentorial lesions, which was cured at 2 weeks after puncture and aspiration. All incisions healed primarily and no redness or swelling occurred. CT scans showed good reposition of the cranial bone flap and smooth inner and outer surfaces of the skull at 2 weeks after operation. All 67 patients were followed up 3-20 months (mean, 10.3 months). During follow-up, the skull had satisfactory appearance without discomfort, local depression, or effusion. Moreover, regular CT and MRI scans showed no subside, or displacement of the cranial bone flap or artifacts. Conclusion Absorbable fixation system for reposition and fixation of the cranial bone flap not only is simple, safe, and reliable, but also can eliminate the postoperative CT or MRI artifact caused by metals fixation system.
Objective To evaluate the directional significance of SurgiCase software in free fibula mandibular reconstruction. Methods Between September 2010 and March 2012, 10 patients with mandibular defect underwent free fibula mandibular reconstruction. There were 7 males and 3 females, with an age range of 19-43 years (mean, 27 years). The extent of lesions was 7 cm × 5 cm to 16 cm × 8 cm. In each case, three-dimensional spiral CT scan of the maxilla, mandible, and fibula was obtained before surgery. The CT data were imported into the SurgiCase software and the virtual surgery planning was performed. After that, the mandibular rapid prototyping was made according to customized design. The reconstruction surgery was then carried out using these preoperative data. During actual surgery, the extent of mandibular defect was from 6 cm × 3 cm to 16 cm × 5 cm; the length of fibula which was used to reconstruct mandible was 6-17 cm; and the area of flap was from 6 cm × 5 cm to 16 cm × 6 cm. Results Preoperative data could not be applied because the intraoperative size of tumor was larger than preoperative design in 1 case of mandibular ameloblastoma, and the fibula was shaped according to the actual osteotomy location; operations were performed successfully according to preoperative design in the other 9 patients. The operation time was 5-7 hours (mean, 6 hours). Primary healing of incision was obtained, without early complications. Ten patients were followed up 1 year. At last follow-up, 8 patients were satisfactory with the appearance and 2 patients complained with unsatisfied wide facial pattern. The panoramic radiograghs showed good bone healing. The range of mouth opening was 2.5-3.5 cm. Conclusion SurgiCase software can provide precise data for free fibula mandibular reconstruction during surgery. It can be applied widely in clinic.
Objective To investigate the effect of sodium hyaluronate (SH) intra-articular injection on the treatment of knee osteoarthritis (OA), andto compare the contents of free radicals and inflammatory factors in joint fluids of pre-and pro-treatment as to explore the treatment mechanism of SH. Methods Ninety-two patients (111 knees) with mild(51)，moderate(35) and serious(25) knee OA were treated with intra-articular injections of SH (20 mg once a week for 5 weeks). According to Lysholm scoring, clinical signs such aspain, swelling,and the ability to walk, squat, run, go upstairs and downstairs were assessed before and after the treatment, and the contents of nitric oxide (NO), superoxide dismutase(SOD), malonic dialdehyde(MDA) and IL-1β、TNF-α in joint fluids from the OA joints before 1st,2nd, and 5th injection and 3 months after each injection were observed. Results All cases were followed up for 3 months. The improvements in the signs and function of knees were excellent in 42 knees, good in 38 knees, fair in 21 knees and poor in 10 knees, with 72.1% excellent and good results. The lighter the illness was, the better the improvement was: the rate of the excellent and good was 92.1% in mild group, 68.6% in moderate group and 42.9% in serious group. The contents of oxygen free radicals and IL-1β、TNF-α of the patients with mild and moderate OA decreasedmarkedly after being treated with SH（Plt;0.05）, but these decreased lightlyin serious OA group（Pgt;0.05）. SH had mild effect on the contents of NO. Three months after treatment, only in mild OA group the contents of NO significantly decreased（Plt;0.05）, and no significant change in moderate and serious groups was observed（Pgt;0.05）. Conclusion SH intraarticular injection has a positive effect on the relief of clinical symptoms and on the improvement of articular function of knee OA. The therapeutical effect of SH on OA is achieved possibly by decreasing the contents of free radicals especially oxygen free radicals and inflammatory factors in joint fluids.
Objective To study the quantitative changes of ubiquitin l igase MAFbx mRNA and protein expression, muscle atrophy and muscle function following free muscle transplantation and to explore relationshi ps among them. Methods Thirty-six female SD rats, SPF grade, weighing (250 ± 25) g, were used. One hind l imb of the rat was randomly selected as experimental side to receive in situ free gracil is muscle transplantation, and the counterlateral hind l imb underwent no operation serving as control side. General condition of the rats was observed after operation. Muscle contractivecapacity and muscle wet weight maintenance rate of the experimental and the control side were detected 1, 2, 4, 10, 15, and 30 weeks after operation, and 6 rats were killed at each time point. Meanwhile, HE staining was performed to observe muscle fibre cross-sectional area, real-time quantitative PCR was appl ied to detect relative expression of MAFbx/Atrogin-1 mRNA, and Western blot test was used to observe MAFbx protein expression. Results All rats survived till the end of the experiment, all incisions healed well, and no dysfunction occurred in the experimental sides. The value of muscle contractive capacity, muscle wet weight maintenance rate, muscle’s maximal force of single contraction, and muscle’s maximal force of tetanic contraction in the experimental sides dramatically decreased in the first 4 weeks after operation and increased gradually over 4 to 30 weeks. The MAFbx mRNA expression of the experimental sides peaked and was seven times greater than the control sides 2 weeks after operation, then the value gradually decreased over 15 to 30 weeks after operation and was 1.1 to 1.5 times greater than the control sides, and significant difference was evident between the experimental sides and the control sides at each time point (P lt; 0.05). Significant difference was evident between the experimental sides and the control sides in terms of MAFbx protein expression of the muscle 1 to 15 weeks after operation according to the Western blot result (P lt; 0.05), and no significant difference was noted at 30 weeks (P gt; 0.05). The correlation coefficient between muscle wet weight maintenance rate and muscle’s maximal force of single contraction maintenance rate was 0.95, between muscle wet weight maintenance rate and muscle’s maximal force of tetanic contraction maintenance rate was 0.75, between muscle fibre cross-sectional area recovery rate and muscle’s maximal force of single contraction maintenance rate was 0.93, and between muscle fibre cross-sectional area recovery rate and muscle’s maximal force of tetanic contraction maintenance rate was 0.68 (P lt; 0.05). The correlation coefficient between MAFbx mRNA expression and the parameter of muscle wet weight maintenance rate, muscle fibre cross-sectional area recovery rate, muscle’s maximal force of single contraction maintenance rate, and muscle’s maximal force of tetanic contraction maintenance rate was — 0.62 (P lt; 0.05), — 0.45 (P gt; 0.05), — 0.72 (P lt; 0.05) and — 0.78 (P lt; 0.05), respectively; the correlation coefficient between MAFbx protein relative expression and the parameter of muscle wet weight maintenance rate, muscle fibre cross-sectional area recovery rate, muscle’s maximal force of single contraction maintenance rate, and muscle’s maximal force of tetanic contraction maintenance rate was — 0.95 (P lt; 0.05), — 0.82 (P lt; 0.05), — 0.89 (P lt; 0.05), and — 0.54 (P gt; 0.05), respectively. Conclusion Decrease of muscle function after transplantation correlates closely with muscle atrophy. The high expression of MAFbx mRNA and protein, especially their persistent increases from 4 to 15 weeks after nerve reinnervation, is a junction between the muscle atrophy and thedecrease of muscle function.
Abstract In order to have more selective sources of skin flaps to repair soft tissue defects, the prefabricated flap combining with skin expander was tried. Implanted the dorsal thoracic artery and vein with a muscle bundle of latissimus dorsi into the lateral thoracic wall subdermally andset a skin expander subcutaneously. Injected saline into the expander to inflate the flap gradually. In a month, an axial flap with the dorsal thoracic vesselswas prepared. the flap was transferred to the defect by vascular anastomosis technique. This method was applied in two cases, one to the left ankle, another to the left side of the neck. The sizes of the two flaps were 20cm×14cmand 22cm×15cm respectively. After operation, the flaps were alive completely. The advantages included selective source of vascular pedicle, thinpliable flap with enough blood supply, and direct closure of the donor site without skin graft.